Department of Surgery and Marshall Institute for Interdisciplinary Research (MIIR), Marshall University School of Medicine, Huntington, WV, USA.
Department of Informatics and Biostatistics, Marshall University School of Medicine, Huntington, WV, USA.
Am Surg. 2024 Nov;90(11):2958-2968. doi: 10.1177/00031348241259045. Epub 2024 Jun 6.
Trauma is a leading cause of global death, with 200 000 deaths and over 3 million non-fatal injuries/year in the United States. We aim to assess trauma care value for patients who underwent urgent laparotomies (LAP) and thoracotomies (THO) in our Health Network System.
Clinical variables (v = 84) from trauma patients (>18 yo) were retrieved retrospectively (Jan-2010 to July-2016) and prospectively (Aug-2016 to Sept-2021) from a Health System warehouse under IRB-approved protocols. Patients were divided according to their Injury Severity Score (ISS) into mild/moderate cases (ISS <15) and severe cases (ISS >15). Value was assessed using quality and cost domains. Quality surrogates included graded postoperative complications (PCs), length of stay (LOS), 30-day readmission (RA), patient satisfaction (PS), and textbook (TB) cases. Total charges (TCs) and reimbursement index ( were included as surrogates for cost. Value domains were displayed in scorecards comparing Observed (O) with Expected (E) (using the ACS risk calculator) outcomes. Uni-/multivariate analyses were performed using SPSS.
41,927 trauma evaluations were performed, leading to 16 044 admissions, with 528 (3.2%) patients requiring urgent surgical procedures (LAP = 413 and THO = 115). Although the M:F ratio (7:3) was similar in LAP vs THO groups, age and BMI were significantly different (41.8 ± 19.1 vs 51.8 ± 19.9 years, 28.6 ± 9.9 vs 27.4 ± 7 Kg/m, respectively, < .05). Blunt trauma was involved in 68.8/77.3% of the LAP/THO procedures, respectively ( < .05). Multivariate analyses showed ISS, age, ASA class, and medical center as factors significantly predicting PC ( < .05). Postoperative complication grades from the LAP/THO groups showed above-average outcomes; nonetheless, LOS was higher than the national averages.
The Trauma Program holds high value in our Health Network System. Protocols for decreasing LOS are being implemented.
创伤是导致全球死亡的主要原因，在美国，每年有 20 万人死亡，300 多万人遭受非致命性伤害/年。我们旨在评估我们的医疗网络系统中接受紧急剖腹术（LAP）和开胸术（THO）的患者的创伤护理价值。
从医疗系统仓库中回顾性（2010 年 1 月至 2016 年 7 月）和前瞻性（2016 年 8 月至 2021 年 9 月）检索（>18 岁）创伤患者的临床变量（v = 84），并根据损伤严重程度评分（ISS）将患者分为轻度/中度病例（ISS<15）和严重病例（ISS>15）。使用质量和成本领域评估价值。质量替代指标包括分级术后并发症（PC）、住院时间（LOS）、30 天再入院（RA）、患者满意度（PS）和教科书（TB）病例。总费用（TCs）和报销指数（作为成本的替代指标。使用 ACS 风险计算器显示观察值（O）与预期值（E）之间的差值（O-E）的记分卡比较了价值域。使用 SPSS 进行单变量/多变量分析。
进行了 41,927 次创伤评估，导致 16,044 例入院，其中 528 例（3.2%）患者需要紧急手术（LAP = 413 例，THO = 115 例）。尽管 LAP 与 THO 组的 M:F 比值（7:3）相似，但年龄和 BMI 差异显著（41.8±19.1 与 51.8±19.9 岁，28.6±9.9 与 27.4±7kg/m，分别，<.05）。LAP/THO 手术分别涉及 68.8%/77.3%的钝性创伤（<.05）。多变量分析显示，ISS、年龄、ASA 分级和医疗中心是显著预测 PC 的因素（<.05）。LAP/THO 组的术后并发症分级显示出高于平均水平的结果；然而，住院时间高于全国平均水平。
我们的医疗网络系统中的创伤计划具有很高的价值。正在实施降低 LOS 的方案。
